2019-08-13T08:26:27-05:00 2018-09-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2017-10-01 020598440 GEORGETOWN HOSPITAL SYSTEM GEOR 8435277100 PO DRAWER 1718 GEORGETOWN SC 29442 ELIZABETH WARD CFO 8435277100 2019-08-13 1 AMY BIBBY P00445891 8282542254 2019-07-09 24.241.144.70 2019-08-13 08:26:07 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 A22AE24AEF09E58E11297D5713887849BDE471CE 2017 2019-02-21 02:37:17Z TIDELANDS HEALTH BRUCE P BAILEY PO DRAWER 1718 GEORGETOWN SC 29442 41610588 0 X WWW.TIDELANDSHEALTH.ORG X 2002 SC HEALTHCARE 15 10 2245 15 0 0 0 0 23740375 26531713 0 0 149021 15078875 23889396 41610588 0 0 0 0 31405427 38697425 0 0 0 10547028 9332140 41952455 48029565 -18063059 -6418977 12275606 29027760 5766696 7190395 6508910 21837365 GEORGETOWN HOSPITAL SYSTEM IS COMMITTED TO PROVIDING HIGH QUALITY HEALTHCARE TO THE CITIZENS OF GEORGETOWN COUNTY AND SURROUNDING AREAS. OUR MISSION IS TO CONTINUOUSLY IMPROVE THE CARE WE ARE ABLE TO RENDER TO EXCEED THE EXPECTATIONS OF OUR PATIENTS AND CUSTOMERS. 0 0 44062082 41610588 TO ASSIST IN THE PROVISION OF HEALTH CARE TO RESIDENTS OF GEORGETOWN COUNTY BY PROVIDING PAYROLL AND MANAGEMENT SERVICES TO WACCAMAW COMMUNITY HOSPITAL AND GEORGETOWN MEMORIAL HOSPITAL, BOTH 501(C)(3) TAX EXEMPT HOSPITALS.THE PROGRAM SERVICE REVENUE RECORDED ON PAGE 9 OF THE FORM 990, AS WELL AS THE FUNCTIONAL EXPENSES ON PAGE 10, REPRESENTS THE ACTIVITIES OF GEORGETOWN PHYSICIAN SERVICES, LLC, A WHOLLY-OWNED DISREGARDED NONPROFIT ENTITY. THESE ACTIVITIES ARE NOT RELATED TO PROVIDING PAYROLL AND MANAGEMENT SERVICES TO GEORGETOWN MEMORIAL HOSPITAL AND WACCAMAW COMMUNITY HOSPITAL. 44062082 1 0 0 0 0 0 0 0 0 0 1 0 1 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 0 0 2245 1 0 0 0 0 0 0 0 0 0 0 X 15 10 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 SC X X ELIZABETH WARD EVP & CFO 8435277102 PO DRAWER 1718 GEORGETOWN SC 29442 MR H MCROY SKIPPER CHAIRMAN (TERM ENDED) 4.00 X X 0 400 0 MR J EDWARD NORRIS III VICE CHAIRMAN 2.00 1.00 X X 0 0 0 MR JULIAN A REYNOLDS JR SECRETARY/TREASURER 2.00 1.00 X X 0 400 0 MR TONY JORDAN TRUSTEE 2.00 1.00 X 0 0 0 MR FRANCIS B FORD JR TRUSTEE 2.00 1.00 X 0 350 0 MR ROBERT L JONES TRUSTEE 2.00 1.00 X 0 0 0 MS JUDITH K INGLE TRUSTEE 2.00 1.00 X 0 400 0 MR DANIEL SCHEFFING TRUSTEE 2.00 1.00 X 0 400 0 DR MARTHENA MORANT TRUSTEE 2.00 1.00 X 0 0 0 MR WILLIE SHELLEY TRUSTEE 2.00 1.00 X 0 400 0 MR MARK NASH TRUSTEE 2.00 1.00 X 0 200 0 MR DAN STACY TRUSTEE 2.00 1.00 X 0 0 0 DR T SCOTT ELLISON TRUSTEE & PHYSICIAN (TERM ENDED) 42.00 1.00 X 657953 0 36839 DR CHRISTINE GERBER TRUSTEE & PHYSICIAN 2.00 1.00 X 0 42557 0 DR WILLIAM GREER TRUSTEE & PHYSICIAN (TERM BEGAN) 42.00 1.00 X 727676 56912 37904 DR GAYLE RICHMOND CHIEF OF STAFF & PHYSICIAN 2.00 1.00 X 0 82704 0 DR MICHAEL RATZ VICE-CHIEF OF STAFF & PHYSICIAN 2.00 1.00 X 133568 15060 14781 BRUCE BAILEY PRESIDENT & CEO 2.00 40.00 X 0 656661 36649 GAYLE RESETAR EXECUTIVE VICE PRESIDENT & COO 2.00 40.00 X 0 471602 28800 ELIZABETH WARD EXECUTIVE VICE PRESIDENT & CFO 2.00 40.00 X 0 371950 20090 RICK KAYLOR GPS PRESIDENT & SENIOR VICE PRES. 2.00 40.00 X 0 386900 23225 DR SARA ADAMS PHYSICIAN 40.00 X 775082 0 39697 DR CATHERINE SWIFT PHYSICIAN 40.00 X 724039 0 34683 DR CAROL BOGDAN PHYSICIAN 40.00 X 735803 0 28956 DR DAVID MILLING PHYSICIAN 40.00 X 641010 1975 37286 DR CHANNING WILLOUGHBY PHYSICIAN 40.00 X 853700 0 39465 TERRY KISER FORMER EXECUTIVE VP & CFO 0.00 X 0 270428 7147 5248831 2359299 385522 65 1 1 1 MARK E TRIANA DO PA 2185 NORTH FRASER STREET GEORGETOWN SC 29440 PHYSICIAN SERVICES 2248245 OMEGA MEDICAL SOLUTIONS LLC 3926 WESLEY STREET UNIT 502 MYRTLE BEACH SC 29579 BILLING SERVICES 1128965 ECLINICALWORKS LLC 2 TECHNOLOGY DRIVE WESBOROUGH MA 01581 INFORMATION TECHNOLOGY 933183 CHANGE HEALTHCARE 3055 LEBANON PIKE STE 100 NASHVILLE TN 37214 INFORMATION TECHNOLOGY 730170 COASTAL STRUCTURES PO BOX 937 COLUMBIA SC 29211 CONSTRUCTION 634469 11 NET PATIENT SERVICE REVENUE 621400 26531713 26531713 26531713 GAIN ON RELATED INVESTMENT 900099 16062585 16062585 LOSS ON RELATED INVESTMENT 900099 -983710 -983710 15078875 41610588 41610588 0 0 32795495 31364433 1431062 1007862 963883 43979 3301975 3157890 144085 1592093 1522621 69472 1438598 1438598 458 458 3717511 2927444 790067 405650 405650 278630 268773 9857 786247 786247 796095 755732 40363 MEDICAL SUPPLIES 1693165 1693165 MISCELLANEOUS EXPENSE 215786 215786 48029565 44062082 3967483 0 291826 249120 2381918 2668979 389233 494018 7150801 3259218 3161635 3891583 2908426 20166259 1557801 1557801 1584767 0 12275606 29027760 3788328 4617838 1978368 2572557 5766696 7190395 X 6508910 21837365 6508910 21837365 12275606 29027760 X -6418977 21747432 X X 0 1 X 1 0 X X 2 GEORGETOWN MEMORIAL HOSPITAL 570341194 3 1 0 19827937 WACCAMAW COMMUNITY HOSPITAL 043633263 3 1 0 24234145 2 0 44062082 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 FORM 990, SCHEDULE A, PART 1, LINE 11 SUPPORT PROVIDED TO SUPPORTED ORGANIZATIONS: THE PURPOSE OF THE GEORGETOWN HOSPITAL SYSTEM IS TO FACILITATE THE PROVISION OF HEALTH CARE SERVICES IN GEORGETOWN COUNTY AND SURROUNDING AREAS. THE SYSTEM PROVIDES STRATEGIC AND OPERATIONAL PLANNING, DIRECTION AND OVERSIGHT, AND DEVELOPS COMMON STRATEGIES AND OPERATIONAL PLANS FOR GEORGETOWN MEMORIAL HOSPITAL, WACCAMAW COMMUNITY HOSPITAL AND OTHER RELATED ENTITIES. THE SYSTEM ALSO PROVIDES CENTRALIZED ADMINISTRATIVE AND HUMAN RESOURCE FUNCTIONS TO ITS ENTITIES BY HIRING ALL EMPLOYEES AND PROVIDING ALL EMPLOYEE BENEFITS WITHIN THE SYSTEM. THE SYSTEM PROVIDES ADMINISTRATIVE SERVICES AND LEASES ITS EMPLOYEES TO ENTITIES AND IN RETURN SUCH ENTITIES REIMBURSE THE SYSTEM FOR THE COST OF THE ADMINISTRATIVE SERVICES AND EMPLOYEES EACH UTILIZES. 1167709 233107 934602 261981 74743 187238 5721111 2951368 2769743 3891583 INVESTMENT IN GEORGETOWN RADIATION THERAPY CENTER, LLC 2831683 F INVESTMENT IN TIDELANDS 608077 F INVESTMENT IN AMEDISYS 1135558 F INVESTMENT IN HEALTHSOUTH 15590941 F 20166259 DUE TO AFFILIATES 2572557 2572557 X 63358020 21747432 21747432 41610588 0 41610588 48029565 0 48029565 0 48029565 PART X, LINE 2: GEORGETOWN HOSPITAL SYSTEM HAS BEEN GRANTED EXEMPTION FROM INCOME TAXES AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. GEORGETOWN RADIATION THERAPY CENTER IS A PARTNERSHIP AND THE RESULTS OF ITS OPERATIONS ARE REPORTED ON THE INCOME TAX RETURNS OF THE PARTNERS. GEORGETOWN PHYSICIAN SERVICES LLC AND GHS TRANSITIONAL CARE LLC ARE 509(A)(3) ORGANIZATIONS OF THE SYSTEM AND ARE EXEMPT FROM INCOME TAXES THROUGH THE SYSTEM. ACCORDINGLY, THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS DO NOT INCLUDE A PROVISION FOR INCOME TAXES. THE SYSTEM HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2018. PART XI, LINE 2D - OTHER ADJUSTMENTS: EQUITY TRANSFER 21,747,432. X X X X 0 0 0 1 1 1 1 1 0 DR T SCOTT ELLISON TRUSTEE & PHYSICIAN (TERM ENDED) 470128 0 150777 0 37048 0 4725 0 32114 0 694792 0 0 0 DR WILLIAM GREER TRUSTEE & PHYSICIAN (TERM BEGAN) 604612 56912 93229 0 29835 0 4725 0 33179 0 765580 56912 0 0 DR MICHAEL RATZ VICE-CHIEF OF STAFF & PHYSICIAN 112218 15060 3240 0 18110 0 0 0 14781 0 148349 15060 0 0 BRUCE BAILEY PRESIDENT & CEO 0 464804 0 134133 0 57724 0 4400 0 32249 0 693310 0 0 GAYLE RESETAR EXECUTIVE VICE PRESIDENT & COO 0 334500 0 98602 0 38500 0 6509 0 22291 0 500402 0 0 ELIZABETH WARD EXECUTIVE VICE PRESIDENT & CFO 0 264259 0 75000 0 32691 0 3301 0 16789 0 392040 0 0 RICK KAYLOR GPS PRESIDENT & SENIOR VICE PRES. 0 281365 0 76408 0 29127 0 8644 0 14581 0 410125 0 0 DR SARA ADAMS PHYSICIAN 375963 0 362350 0 36769 0 4725 0 34972 0 814779 0 0 0 DR CATHERINE SWIFT PHYSICIAN 378294 0 301432 0 44313 0 4725 0 29958 0 758722 0 0 0 DR CAROL BOGDAN PHYSICIAN 210988 0 458181 0 66634 0 4725 0 24231 0 764759 0 0 0 DR DAVID MILLING PHYSICIAN 378907 1975 225863 0 36240 0 4725 0 32561 0 678296 1975 0 0 DR CHANNING WILLOUGHBY PHYSICIAN 365795 0 451320 0 36585 0 4725 0 34740 0 893165 0 0 0 TERRY KISER FORMER EXECUTIVE VP & CFO 0 10830 0 97079 0 162519 0 3319 0 3828 0 277575 0 0 PART I, LINE 4 TERRY KISER MADE CONTRIBUTIONS TO A NON-QUALIFIED 409A PLAN UNTIL HIS RETIREMENT IN MARCH 2017. PART I, LINE 5 INCENTIVE COMPENSATION PAID IS CONTINGENT UPON QUALITY INDICATORS, NET REVENUES, AND THE OVERALL PROFITABILITY OF THE ORGANIZATION. IF PREDETERMINED GOALS ARE MET, INCENTIVE COMPENSATION IS PAID IN ACCORDANCE WITH AN INCENTIVE COMPENSATION PROGRAM. SEE PART II, COLUMN (B)(II). PART I, LINE 6 SEE THE RESPONSE TO LINE 5A AND 5B. PART I, LINE 7 GEORGETOWN PHYSICIAN SERVICES PHYSICIAN INCENTIVE COMPENSATION INCLUDES, BUT IS NOT LIMITED TO SIGN ON, PRODUCTIVITY AND PATIENT QUALITY BONUSES. QUALITY BONUSES ARE BASED ON THE PHYSICIAN EMPLOYMENT CONTRACT, BUT MAY BE AMENDED IN ADVANCE AT THE DISCRETION OF GEORGETOWN PHYSICIAN SERVICES. PART II COMPENSATION FROM UNRELATED ORGANIZATION: COMPENSATION PAID TO TERRY KISER WAS PAID THROUGH QUORUM HEALTH RESOURCES (QHR), AN UNRELATED MANAGEMENT COMPANY. ALL AMOUNTS LISTED ON SCHEDULE J, PART II, LINE (I) FOR HIM ARE FROM QHR. FORM 990, PART VI, SECTION A, LINE 1 THE BOARD OF TRUSTEES SHALL DESIGNATE FROM AMONG ITS MEMBERS AN EXECUTIVE COMMITTEE, WHICH SHALL CONSIST OF FIVE OR MORE TRUSTEES, INCLUDING THE CHAIRMAN, THE VICE CHAIRMAN, THE SECRETARY, AND THE TREASURER OF THE CORPORATION, WHICH EXECUTIVE COMMITTEE, TO THE EXTENT PROVIDED IN A RESOLUTION TO THE BOARD, SHALL HAVE AND EXERCISE THE AUTHORITY OF THE BOARD OF TRUSTEES IN OVERSEEING OR GUIDING THE MANAGEMENT OF THE AFFAIRS OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 2 MR. H. MCROY SKIPPER AND MR. TONY JORDAN SHARE FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11B THE RETURN WAS PREPARED BY AN OUTSIDE ACCOUNTING FIRM WITH THE ASSISTANCE AND OVERSIGHT OF MANAGEMENT. A REPRESENTATIVE OF THE ACCOUNTING FIRM PRESENTED THE RETURN TO THE FINANCE COMMITTEE WITH MANAGEMENT AND ANSWERED QUESTIONS FROM BOARD MEMBERS. THE CEO AND CFO THEN REVIEWED THE FORM WITH ALL BOARD MEMBERS, AS EVIDENCED IN THE BOARD MINUTES. A COPY OF THE RETURN WAS PROVIDED TO EACH VOTING BOARD MEMBER. AFTER A DISCUSSION PERIOD, THE BOARD VOTED TO APPROVE THE FILING OF THE FORM 990 WITH THE IRS AS PRESENTED. THE CFO/CEO MET IN PERSON WITH ANY MEMBERS ABSENT FROM THE MEETING TO DISCUSS THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY WHICH IS REVIEWED, ACCEPTED, AND SIGNED BY EACH OFFICER AND VOTING BOARD MEMBER ON AN ANNUAL BASIS. PURSUANT TO THIS POLICY, EACH OFFICER AND BOARD MEMBER WILL RECUSE HIMSELF OR HERSELF FROM ANY DISCUSSIONS AND VOTES FOR WHICH A CONFLICT EXISTS. DETERMINATION OF WHETHER A CONFLICT EXISTS IS MADE AT A MANAGEMENT, BOARD MEMBER, OFFICER, AND INDIVIDUAL LEVEL. ACTUAL CONFLICTS ARE REVIEWED BY MANAGEMENT AND THE BOARD WITHOUT THE PRESENSE OF THE INTERESTED PARTY. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION USES OUTSIDE AGENCIES TO ESTABLISH, ASSESS THE REASONABLENESS OF, REVIEW, AND APPROVE THE COMPENSATION OF DIRECTORS, SENIOR MANAGEMENT & PHYSICIANS. SENIOR MANAGEMENT PROVIDES OVERSIGHT ON DIRECTOR COMPENSATION, THE BOARD COMPENSATION COMMITTEE PROVIDES OVERSIGHT ON PHYSICIAN COMPENSATION AND THE CEO PROVIDES OVERSIGHT (WITH THE ASSISTANCE OF THE CFO) ON SENIOR MANAGEMENT COMPENSATION. CEO COMPENSATION IS EVALUATED AND APPROVED BY THE FULL BOARD AND BOARD COMPENSATION COMMITTEE. FAIR MARKET VALUATIONS ARE COMPLETED FOR ALL COMPENSATION AT LEAST ANNUALLY AND MONTHLY COMPENSATION MEETINGS ARE HELD TO REVIEW ANY AND ALL COMPENSATION RELATED ACTIVITIES. FORM 990, PART VI, SECTION C, LINE 18 PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. FORM 990, PART XI, LINE 9: EQUITY TRANSFER 21,747,432. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART VII, LINE 1A: FORMER CHIEFS OF STAFF MAY CONTINUE TO BE COMPENSATED FOR EMERGENCY ROOM CALL PAY, COMMITTEE PAY, ETC. GEORGETOWN PHYSICIAN SERVICES LLC 606 BLACK RIVER ROAD GEORGETOWN SC 29440 261306753 HEALTHCARE SC 26531713 7303701 GEORGETOWN HOSPITAL SYSTEM GHS TRANSITIONAL CARE LLC 606 BLACK RIVER ROAD GEORGETOWN SC 29440 462161616 HEALTHCARE SC 15917627 18892377 GEORGETOWN HOSPITAL SYSTEM GEORGETOWN MEMORIAL HOSPITAL PO BOX 1718 GEORGETOWN SC 29442 570341194 HEALTHCARE SC 501(C)(3) LINE 3 GEORGETOWN HOSPITAL SYSTEM 1 WACCAMAW COMMUNITY HOSPITAL PO BOX 3350 MURRELLS INLET SC 29576 043633263 HEALTHCARE SC 501(C)(3) LINE 3 GEORGETOWN HOSPITAL SYSTEM 1 GEORGETOWN RADIATION THERAPY CENTER 4033 HIGHWAY 17 BYPASS MURRELLS INLET SC 29576 200131459 HEALTHCARE SC GEORGETOWN HOSPITAL SYSTEM RELATED -451349 2831683 0 0 0.51000 0 0 0 0 1 0 0 0 1 1 1 1 0 1 1 1 1 0 1 WACCAMAW COMMUNITY HOSPITAL O 44332537 I/C ALLOCATION GEORGETOWN MEMORIAL HOSPITAL O 69586657 I/C ALLOCATION WACCAMAW COMMUNITY HOSPITAL E 2572557 END OF YEAR BALANCE WACCAMAW COMMUNITY HOSPITAL K 420816 COST GEORGETOWN MEMORIAL HOSPITAL K 619188 COST GEORGETOWN MEMORIAL HOSPITAL S 21747432 COST GEORGETOWN MEMORIAL HOSPITAL Q 1622206 COST WACCAMAW COMMUNITY HOSPITAL Q 3830557 COST